401k Plan data: MID JEFFERSON EXTENDED CARE HOSPITAL plan

MID JEFFERSON EXTENDED CARE HOSPITAL 401k Plan overview

Plan Name	MID JEFFERSON EXTENDED CARE HOSPITAL
Plan identification number	501

MID JEFFERSON EXTENDED CARE HOSPITAL Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

POST ACUTE ENTERPRISES LLC has sponsored the creation of one or more 401k plans.

Company Name: POST ACUTE ENTERPRISES LLC

Employer identification number (EIN): 472560012

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MID JEFFERSON EXTENDED CARE HOSPITAL

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-09-01
501 2016-09-01
501 2015-09-01 WESLEY MCLELLAND

Plan Statistics for MID JEFFERSON EXTENDED CARE HOSPITAL

401k plan membership statisitcs for MID JEFFERSON EXTENDED CARE HOSPITAL

Measure Date Value
2017: MID JEFFERSON EXTENDED CARE HOSPITAL 2017 401k membership
Total participants, beginning-of-year 2017-09-01 267
Total number of active participants reported on line 7a of the Form 5500 2017-09-01 240
Number of retired or separated participants receiving benefits 2017-09-01 2
Number of other retired or separated participants entitled to future benefits 2017-09-01 5
Total of all active and inactive participants 2017-09-01 247
Number of employers contributing to the scheme 2017-09-01 0
2016: MID JEFFERSON EXTENDED CARE HOSPITAL 2016 401k membership
Total participants, beginning-of-year 2016-09-01 167
Total number of active participants reported on line 7a of the Form 5500 2016-09-01 267
Number of retired or separated participants receiving benefits 2016-09-01 0
Number of other retired or separated participants entitled to future benefits 2016-09-01 0
Total of all active and inactive participants 2016-09-01 267
2015: MID JEFFERSON EXTENDED CARE HOSPITAL 2015 401k membership
Total participants, beginning-of-year 2015-09-01 168
Total number of active participants reported on line 7a of the Form 5500 2015-09-01 167
Number of retired or separated participants receiving benefits 2015-09-01 1
Number of other retired or separated participants entitled to future benefits 2015-09-01 0
Total of all active and inactive participants 2015-09-01 168

Measure	Date	Value
2017: MID JEFFERSON EXTENDED CARE HOSPITAL 2017 401k membership
Total participants, beginning-of-year	2017-09-01	267
Total number of active participants reported on line 7a of the Form 5500	2017-09-01	240
Number of retired or separated participants receiving benefits	2017-09-01	2
Number of other retired or separated participants entitled to future benefits	2017-09-01	5
Total of all active and inactive participants	2017-09-01	247
Number of employers contributing to the scheme	2017-09-01	0
2016: MID JEFFERSON EXTENDED CARE HOSPITAL 2016 401k membership
Total participants, beginning-of-year	2016-09-01	167
Total number of active participants reported on line 7a of the Form 5500	2016-09-01	267
Number of retired or separated participants receiving benefits	2016-09-01	0
Number of other retired or separated participants entitled to future benefits	2016-09-01	0
Total of all active and inactive participants	2016-09-01	267
2015: MID JEFFERSON EXTENDED CARE HOSPITAL 2015 401k membership
Total participants, beginning-of-year	2015-09-01	168
Total number of active participants reported on line 7a of the Form 5500	2015-09-01	167
Number of retired or separated participants receiving benefits	2015-09-01	1
Number of other retired or separated participants entitled to future benefits	2015-09-01	0
Total of all active and inactive participants	2015-09-01	168

Form 5500 Responses for MID JEFFERSON EXTENDED CARE HOSPITAL

2017: MID JEFFERSON EXTENDED CARE HOSPITAL 2017 form 5500 responses
2017-09-01	Type of plan entity	Single employer plan
2017-09-01	Plan funding arrangement – Insurance	Yes
2017-09-01	Plan benefit arrangement – Insurance	Yes
2016: MID JEFFERSON EXTENDED CARE HOSPITAL 2016 form 5500 responses
2016-09-01	Type of plan entity	Single employer plan
2016-09-01	Submission has been amended	No
2016-09-01	This submission is the final filing	No
2016-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-09-01	Plan is a collectively bargained plan	No
2016-09-01	Plan funding arrangement – Insurance	Yes
2016-09-01	Plan benefit arrangement – Insurance	Yes
2015: MID JEFFERSON EXTENDED CARE HOSPITAL 2015 form 5500 responses
2015-09-01	Type of plan entity	Single employer plan
2015-09-01	First time form 5500 has been submitted	Yes
2015-09-01	Submission has been amended	No
2015-09-01	This submission is the final filing	No
2015-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-09-01	Plan is a collectively bargained plan	No
2015-09-01	Plan funding arrangement – Insurance	Yes
2015-09-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

7008340701

Policy instance

Insurance contract or identification number	7008340701
Number of Individuals Covered	183
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $11,268
Total amount of fees paid to insurance company	USD $1,961
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $92,754
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )

Policy contract number

78A86ERC

Policy instance

Insurance contract or identification number	78A86ERC
Number of Individuals Covered	338
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $53,773
Total amount of fees paid to insurance company	USD $26,695
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0011145759

Policy instance

Insurance contract or identification number	0011145759
Number of Individuals Covered	47
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $7,313
Total amount of fees paid to insurance company	USD $638
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,472
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

700821*

Policy instance

Insurance contract or identification number	700821*
Number of Individuals Covered	240
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $46,389
Total amount of fees paid to insurance company	USD $7,170
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT,ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $289,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )

Policy contract number

78A86ERC

Policy instance

Insurance contract or identification number	78A86ERC
Number of Individuals Covered	225
Insurance policy start date	2015-09-01
Insurance policy end date	2016-08-31
Total amount of commissions paid to insurance broker	USD $79,138
Total amount of fees paid to insurance company	USD $1,844
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $70,203
Amount paid for insurance broker fees	1844
Additional information about fees paid to insurance broker	INDIRECT COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL INS. SVCES., INC.

SOUTHERN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60009 )

Policy contract number

78A86ERC

Policy instance

Insurance contract or identification number	78A86ERC
Number of Individuals Covered	168
Insurance policy start date	2015-09-01
Insurance policy end date	2016-08-31
Total amount of commissions paid to insurance broker	USD $26,588
Total amount of fees paid to insurance company	USD $754
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $132,790
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $22,510
Amount paid for insurance broker fees	754
Additional information about fees paid to insurance broker	INDIRECT COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL INS SVCES, INC

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Company Name:	POST ACUTE ENTERPRISES LLC
Employer identification number (EIN):	472560012
NAIC Classification:	622000
NAIC Description:	Hospitals